The Murky World of Direct-to-Consumer Telehealth

With easy access to medical services and prescriptions, the consumer appeal of direct-to-consumer telehealth providers is clear. But the disadvantages are equally clear.

Closeup of woman with empty blister pack of pills using telehealth pharmacy on a smartphone at home

Read Time: 3 minutes


You’ve likely seen television advertisements for companies offering quick solutions for poor mental health, hair loss, or erectile dysfunction. Such companies include Hims, Hers, Amwell, and Roman. This industry expanded during the COVID-19 pandemic with many private pharmacy and health care companies transitioning to telehealth services, mailing products to people at home.

Ashwini Nagappan and colleagues outlined the pros and cons of direct-to-consumer telemedicine and the implications of this growing trend. The researchers highlighted themes from 86 studies that discussed ethical issues with telehealth services. The studies consistently described the features of these services in similar terms: a focus on medical issues with an associated stigma, little to no face-to-face time with a medical professional, and a tendency to refuse insurance company payment. 

The consumer appeal of these alternative health providers is clear. Direct-to-consumer telehealth offers customers easy access to particular medical services and quick receipt of prescription medications. But, the disadvantages are equally clear.

The benefits of anonymity and convenience may be compromised by the health risks of unregulated or suboptimal products. 

Nagappan and colleagues found that patient-driven telemedicine services threatened personal safety because the services and products are often not adequately tested to ensure their safety and effectiveness. These services also jeopardize personal privacy due to potential data sharing. And they increase financial demand due to out-of-pocket expenses for treatments that often would be covered by insurance. Additionally, the medical evaluation before online prescription can be haphazard, which can result in psychological distress due to inadequate treatment or testing. Of the 86 studies synthesized by Nagappan, over half highlighted that the companies involved often engage in misleading advertising, questionable quality assurance, and purposeful concealment of information to mislead customers.

The online pharmaceutical industry is one area of telehealth that warrants particular attention.

People are turning to online pharmacies for the same reasons they turn to other direct-to-consumer telehealth: the hassle of the health care system and individual embarrassment around picking up certain medications in person. The online pharmacy market has rapidly grown in the last few years and with this growth the number of unregulated, illegal pharmacies now exceeds fully-licensed pharmacies.

Yam Limbu and Bruce Huhmann examined the existing research on illicit online pharmacies, defining these as pharmacies that do not meet national or international pharmacy regulations.

The researchers report that pharmacies often sell counterfeit, misbranded, or unapproved prescription drugs that pose a potential risk to customers. They also don’t regularly require valid prescriptions from licensed providers.

As more people rely on these types of services, there is a need for greater oversight and regulation. Buyers should be cautious before receiving direct-to-consumer telehealth services, spending time to learn more about the companies they plan to use and read reviews of their services, as one would before any important purchase. The benefits of anonymity and convenience may be compromised by the health risks of unregulated or suboptimal products.